| Spine Specialist | |
|
1187 Main Ave Ste 1d, Clifton, NJ 07011-2252 | |
| (973) 742-0927 | |
| (888) 373-2114 |
| Full Name | Spine Specialist |
|---|---|
| Type | Facility |
| Speciality | Chiropractor - Neurology |
| Location | 1187 Main Ave Ste 1d, Clifton, New Jersey |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407165111 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 111NN0400X | Chiropractor - Neurology | 38MC00673900 (New Jersey) | Primary |
| 111NN0400X | Chiropractor - Neurology | X0116921 (New York) | Secondary |
| Provider Name | Marco Antonio Lopez |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1073838991 PECOS PAC ID: 6901079748 Enrollment ID: I20111024000293 |
| Mailing Address | Practice Location Address |
|---|---|
| Spine Specialist Po Box 7036, West Orange, NJ 07052-7036 Ph: (973) 742-0927 | Spine Specialist 1187 Main Ave Ste 1d, Clifton, NJ 07011-2252 Ph: (973) 742-0927 |
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